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Bacteriophage ϕX174 has been widely used as a model organism to study fundamental processes in molecular biology. However, several aspects of ϕX174 gene regulation are not fully resolved. Here we construct a computational model for ϕX174 and use the model to study gene regulation during the phage infection cycle. We estimate the relative strengths of transcription regulatory elements (promoters and terminators) by fitting the model to transcriptomics data. We show that the specific arrangement of a promoter followed immediately by a terminator, which occurs naturally in the ϕX174 genome, poses a parameter identifiability problem for the model, since the activity of one element can be partially compensated for by the other. We also simulate ϕX174 gene expression with two additional, putative transcription regulatory elements that have been proposed in prior studies. We find that the activities of these putative elements are estimated to be weak, and that variation in ϕX174 transcript abundances can be adequately explained without them. Overall, our work demonstrates that ϕX174 gene regulation is well described by the canonical set of promoters and terminators widely used in the literature., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hill et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Patient education is crucial for preventing hospital falls, yet workforce constraints can hinder targeted delivery. Utilising supervised healthcare assistants can enhance standard care. This study sought to understand factors that impact the feasibility of supplementing usual care with patient falls education delivered by supervised allied health assistants., Methods: In a qualitative study nested within a randomised controlled trial, focus groups and interviews were conducted with twelve health assistants, seven allied health professionals and two managers from the participating hospital. This elicited insights on barriers and facilitators to implementing workforce redesign to deliver tailored patient falls education. An inductive approach was used to thematically analyse the data., Results: Three key themes emerged: (i) it was feasible for health assistants to deliver hospital patient education; (ii) patients engaged with hospital falls prevention education delivered by assistants; (iii) hospital workforce redesign can be successfully implemented provided there is system-wide buy-in., Conclusions: Health assistants can be trained to successfully deliver hospital falls prevention education provided they have adequate supervision, training, and resources., Practice Implications: Sustained implementation requires dedicated staffing hours for service delivery and staff education., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. All procedures were performed in compliance with relevant laws and institutional guidelines and have been approved by the La Trobe University Human Research Ethics Committee (HEC21429, 16/05/2022)., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Therapeutic approaches aimed at lowering toxic mutant huntingtin (mHTT) levels in the brain can reverse disease phenotypes in animal models of Huntington's disease (HD) and are currently being evaluated in clinical trials. Sensitive and dynamic response biomarkers are needed to assess the efficacy of such candidate therapies. Neurofilament light chain (NfL) is a biomarker of neurodegeneration that increases in cerebrospinal fluid (CSF) and blood with progression of HD. However, it remains unknown whether NfL in biofluids could serve as a response biomarker for assessing the efficacy of disease-modifying therapies for HD., Methods: Longitudinal plasma and cross-sectional CSF samples were collected from the YAC128 transgenic mouse model of HD and wild-type (WT) littermate control mice throughout the natural history of disease. Additionally, biofluids were collected from YAC128 mice following intracerebroventricular administration of an antisense oligonucleotide (ASO) targeting the mutant HTT transgene (HTT ASO), at ages both before and after the onset of disease phenotypes. NfL concentrations in plasma and CSF were quantified using ultrasensitive single-molecule array technology., Results: Plasma and CSF NfL concentrations were significantly elevated in YAC128 compared to WT littermate control mice from 9 months of age. Treatment of YAC128 mice with either 15 or 50 µg HTT ASO resulted in a dose-dependent, allele-selective reduction of mHTT throughout the brain at a 3-month interval, which was sustained with high-dose HTT ASO treatment for up to 6 months. Lowering of brain mHTT prior to the onset of regional brain atrophy and HD-like motor deficits in this model had minimal effect on plasma NfL at either dose, but led to a dose-dependent reduction of CSF NfL. In contrast, initiating mHTT lowering in the brain after the onset of neuropathological and behavioural phenotypes in YAC128 mice resulted in a dose-dependent stabilization of NfL increases in both plasma and CSF., Conclusions: Our data provide evidence that the response of NfL in biofluids is influenced by the magnitude of mHTT lowering in the brain and the timing of intervention, suggesting that NfL may serve as a promising exploratory response biomarker for HD., (© 2024. The Author(s).)

Importance: Informal caregivers who provide home-based care frequently experience stress and burden that adversely affect their health-related quality of life (HRQOL)., Objective: To evaluate the efficacy of the Further Enabling Care at Home (FECH+) program for the HRQOL of caregivers of older adults discharged home from the hospital., Design, Setting, and Participants: This multicenter, parallel, 2-group randomized clinical trial, with blinded baseline and outcome measurements, was conducted at 3 hospitals in 2 states in Australia. Recruitment took place between August 2020 and July 2022, and follow-up was performed for 12 months after hospital discharge. Participants were dyads of caregivers and patients. Eligible caregivers were aged 18 years or older who provided informal home-based care at least weekly for a patient aged 70 years or older. Caregivers were enrolled when their patient was discharged from the hospital. Dyads were randomly assigned to either the intervention or control group. Data analysis followed an intention-to-treat approach., Intervention: Caregivers in the intervention group received the FECH+ program, structured nurse support of 6 telephone calls over 6 months after the patient's discharge plus usual discharge care. Caregivers in the control group received usual care alone., Main Outcomes and Measures: Primary outcome was caregivers' HRQOL 6 months after discharge, which was measured using the Assessment of Quality of Life 8-Dimension (AQOL-8D). Secondary outcomes were caregivers' HRQOL 12 months after discharge as well as preparedness to care (measured using the Preparedness for Caregiving Scale), self-efficacy (measured using the Caregiver Inventory), and levels of strain and distress (measured using the Family Appraisal of Caregiving Questionnaire) at 6 and 12 months after discharge. Baseline and outcome measurements were administered by telephone at 3, 6, and 12 months after discharge., Results: A total of 547 dyads (caregivers: 405 females [74.0%], mean [SD] age, 64.50 [12.82] years; patients: 296 females [54.1%], mean [SD] age, 83.16 [7.04] years for the intervention group and 83.45 [7.20] years for the control group) were included in the intention-to-treat analysis. There was no significant difference in caregivers' HRQOL between the 2 groups at the primary time point of 6 months (difference in AQOL-8D score, 0.01; 95% CI, -0.02 to 0.03; P = .62) after hospital discharge., Conclusions and Relevance: In this randomized clinical trial, the FECH+ program-a nurse telephone support intervention for caregivers of older adults after hospital discharge-did not significantly improve caregivers' HRQOL at 6 months after discharge compared with usual care. Additional examination is warranted into improving caregivers' HRQOL at the time of their patient's hospital discharge., Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943.

Background: Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies., Methods: Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach., Results: Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies., Conclusion: Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Dietary intake has been associated with pain and physical function, but it is unclear if these relationships are mediated by adiposity. Data were derived from the Whyalla Intergenerational Study of Health (n = 654, 57% women). Structural equation modelling tested the hypotheses that adiposity (body mass index (BMI), waist circumference (WC), or body fat (BF, dual energy x-ray absorptiometry)) would mediate the relationship between diet quality (Dietary Guideline Index (DGI) total, core, or non-core scores) and pain (Short Form-36 bodily pain scale (SF36-BPS)), or physical function (grip-strength), overall, and by gender. Adiposity did not mediate a relationship between DGI scores and pain. Direct effects were observed between DGI total scores and SF36-BPS accounting for BMI (β = 0.170, 95% CI 0.002, 0.339), and between DGI core food scores and SF36-BPS (BMI, β = 0.278, 95% CI 0.070, 0.486; WC, β = 0.266, 95% CI 0.058, 0.474; BF, β = 0.266, 95% CI 0.060, 0.473). In women, direct effects existed between DGI scores and SF36-BPS (DGI total scores, BMI, β = 0.388, 95% CI 0.162, 0.613; WC, β = 0.372, 95% CI 0.146, 0.598; BF, β = 0.382, 95% CI 0.158, 0.605, and DGI core scores, BMI, β = 0.482, 95% CI 0.208, 0.757; WC, β = 0.472, 95% CI 0.197, 0.747; BF, β = 0.467, 95% CI 0.195, 0.739), and DGI total scores and grip-strength (BMI, β = 0.075, 95% CI 0.008, 0.142; WC, β = 0.076, 95% CI 0.009, 0.143; BF, β = 0.079, 95% CI 0.011, 0.146). Better diet quality is associated with lower bodily pain, irrespective of adiposity. Findings highlight the potential role of diet quality in pain management and function, particularly in women., Competing Interests: Author declarations The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: World falls guidelines recommend that hospitalised older patients receive individualised falls prevention education, yet no studies have sought older people's feedback on how best to deliver falls prevention education in hospitals. The objective of the study was to explore the perspectives of older people and their caregivers about barriers and enablers to implementation of a tailored hospital falls education program., Methods: A qualitative descriptive design was used. Three focus groups and 16 semi-structured interviews were conducted. A purposive sample of older people who had previous hospital admissions and caregivers of older people were selected to review a co-designed patient falls education program (the revised Safe Recovery program). They provided feedback on how to implement the program in hospital settings. Data were thematically analysed taking an deductive-inductive approach., Results: Participants were 37 older people [female n = 24 (64.9%), age range 64 to 89 years] and nine caregivers (female n = 8). The first theme was that the Safe Recovery Program resources were of high quality, enabling strong patient engagement and increased knowledge and awareness about falls prevention in hospitals. The second theme identified practical strategies to enable program delivery in hospital wards. The key enablers identified were: timing of delivery around wellness and the patient's mobility; tailoring messages for each older patient; key staff members being assigned to lead program delivery. Participants recommended that staff assist older patients to set appropriate behavioural goals in relation to preventing falls in hospitals. They also recommended that staff raise older patients' confidence and motivation to take action to reduce the risk of falls. Providing resources in other languages and alternative shorter versions was recommended to enable broad dissemination., Conclusions: Older people and their caregivers advised that implementing falls education in hospitals can be enabled by using high quality resources, delivering falls education in a timely manner and personalising the education and support to individual needs., (© 2024. The Author(s).)

Purpose: To explore paramedics' experiences and perspectives about attending and managing older adults who had fallen., Procedures: This qualitative, exploratory study used a purposive sample of paramedics in Western Australia. Participants had at least one year of clinical experience. Semi-structured interviews were undertaken. Data were analysed via an inductive thematic approach., Findings: Fourteen paramedics were interviewed (Median age: 38 years, n = 5 females). The main theme identified that experiences were positive when attending patients with high-acuity medical problems or injuries following falls because binary decision-making (transport vs non-transport) was appropriate. Themes highlighted that decision-making for low-acuity falls attendances was a complex balance between 1) patient context, 2) risk management, 3) paramedic reactions, and 4) the lack of alternate referral pathways available. Experiences could be stressful and frustrating when attending falls call-outs for older adults with no injuries or medical problems. Participants concurred that when transport to hospital was not required there were no available, alternative pathways to refer onwards for appropriate health or social care., Conclusion: Attending low-acuity call-outs for falls was often frustrating and required complex decision-making, with gaps in services identified. Further exploration of alternative referral pathways for health care for pre-hospital management of adults who fall is required., Competing Interests: Declaration of Competing Interest AMH is supported by a National Health and Medical Research Council (NHMRC) of Australia Investigator (EL2) award (GNT1174179) and the Royal Perth Hospital Research Foundation. JF is supported by an NHMRC Investigator (L1) award (GNT1174838) and receives research funds from St John WA. RB is employed by St John WA. The authors report there are no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Hospital falls continue to be a persistent global issue with serious harmful consequences for patients and health services. Many clinical practice guidelines now exist for hospital falls, and there is a need to appraise recommendations., Method: A systematic review and critical appraisal of the global literature was conducted, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Embase, CINAHL, MEDLINE, Epistemonikos, Infobase of Clinical Practice Guidelines, Cochrane CENTRAL and PEDro databases were searched from 1 January 1993 to 1 February 2024. The quality of guidelines was assessed by two independent reviewers using Appraisal of Guidelines for Research and Evaluation Global Rating Scale and Appraisal of Guidelines of Research and Evaluation Recommendation Excellence (AGREE-REX). Certainty of findings was rated using Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research. Data were analysed using thematic synthesis., Results: 2404 records were screened, 77 assessed for eligibility, and 20 hospital falls guidelines were included. Ten had high AGREE-REX quality scores. Key analytic themes were as follows: (i) there was mixed support for falls risk screening at hospital admission, but scored screening tools were no longer recommended; (ii) comprehensive falls assessment was recommended for older or frail patients; (iii) single and multifactorial falls interventions were consistently recommended; (iv) a large gap existed in patient engagement in guideline development and implementation; (v) barriers to implementation included ambiguities in how staff and patient falls education should be conducted, how delirium and dementia are managed to prevent falls, and documentation of hospital falls., Conclusion: Evidence-based hospital falls guidelines are now available, yet systematic implementation across the hospital sector is more limited. There is a need to ensure an integrated and consistent approach to evidence-based falls prevention for a diverse range of hospital patients., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Background: Providing older patients with an opportunity to participate in individualised falls preventive education, has been shown to reduce hospital falls. However, few studies have explored older peoples' perspectives of hospital falls prevention education. This study aimed to explore older people and their caregivers' knowledge and awareness about hospital falls prevention, including their reflections on the education they received when hospitalised., Methods: A qualitative, exploratory study with focus groups and semistructured interviews was conducted. Participants were a purposively selected sample of community-dwelling older people (65+ years) admitted to a hospital in the past 5 years and caregivers of older people. Data were thematically analysed using deductive and inductive approaches, and a capability-opportunity-motivation-behaviour model was applied to understand key determinants of implementing falls education for hospitalised older people., Results: Participants' [n = 46 (older people n = 37, age range 60-89 years), caregivers n = 9] feedback identified five themes: distress and disempowerment if the participant did have a hospital fall or nearly fell, anxiety and uncertainty about what behaviour was required while in hospital, insufficient and inconsistent falls prevention education, inadequate communication and underlying attitudes of ageism. Applying a behaviour change model suggested that older people and their caregivers did not develop falls prevention knowledge, awareness or motivation to engage in falls prevention behaviour. Older people were also provided with limited opportunities to engage in falls preventive behaviour while in hospital., Conclusion: Older people in our study received sporadic education about falls prevention during their hospital admissions which did not raise their awareness and knowledge about the risk of falls or their capability to engage in safe falls preventive behaviour. Conflicting messages may result in older people feeling confused and anxious about staying safe in hospital., (© 2024 The Author(s). International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Aims: This cross-sectional observational study quantified Australian Football League Women's athletes' match volume, and compared match-day dietary intakes against recommendations., Methods: Self-report, direct observation, and fluid measurements determined dietary intake (n = 17, 25 ± 4.5 years, 22.8 ± 1.8 kg/m 2 ) on five home match days (early or late starting). Global positioning system software captured match volume. Linear mixed effects models evaluated differences in early versus late match volume and nutrient intakes. Data are presented as mean ± standard deviation., Results: Athletes covered 6712 ± 622 m during matches, with similar numbers of very high-intensity running efforts over equal distances in early and late matches (early vs. late efforts [no.]: 8.5 ± 4.9 vs. 9.5 ± 5.5; distance [m]: 203 ± 127 vs. 212 ± 113). Across all match days, 71% (n = 12) of athletes met their predicted daily energy requirements. However, 82% (n = 14) failed to meet minimum daily carbohydrate recommendations; intake was lower on early compared with late match days (4.7 g/day vs. 5.4 g/kg/day, p = 0.027). On average, no athletes met carbohydrate recommendations in the 2 h prior to a match and only 24% (n = 4) met recommendations during matches. All athletes met post-match carbohydrate and protein requirements., Conclusion: Athletes cover large distances during games with frequent bursts of high-intensity running. However, they do not adjust their intake to meet the energy demands of competition, with inadequate fuelling prior to and during matches. These findings emphasise the need for greater athlete education and dietary support to maximise strategic fuelling to optimise athletic performance., (© 2024 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia.)

Background: The relationship between adiposity and pain is complex. Excess weight increases the risk for chronic musculoskeletal pain (CMP), driven by increased biomechanical load and low-grade systemic inflammation. Pain limits physical function, impacting energy balance contributing to weight gain. The primary aims of this study were to profile pain characteristics in participants with overweight or obesity and determine if weight loss through dietary-induced energy restriction, and presence of CMP, or magnitude of weight loss, was associated with changes in adiposity, pain, functional mobility, and inflammation., Methods: This was a secondary analysis of data from adults (25-65 years) with overweight or obesity (BMI 27.5-34.9 kg/m 2 ) enrolled in a 3-month, 30% energy-restricted dietary intervention to induce weight loss (January 2019-March 2021). Anthropometric measures (weight, waist circumference and fat mass), pain prevalence, pain severity (McGill Pain Questionnaire, MPQ), pain intensity (Visual Analog Scale, VAS), functional mobility (timed up and go, TUG) and inflammation (high sensitivity C-Reactive Protein, hsCRP) were assessed at baseline and 3-months., Results: One hundred and ten participants completed the intervention and had weight and pain assessed at both baseline and 3-months. Participants lost 7.0 ± 0.3 kg, representing 7.9% ± 3.7% of body mass. At 3-months, functional mobility improved (TUG -0.2 ± 0.1 s, 95% CI -0.3, -0.1), but there was no change in hsCRP. Compared to baseline, fewer participants reported CMP at 3-months ( n  = 56, 51% to n  = 27, 25%, p  < 0.001) and presence of multisite pain decreased from 22.7% to 10.9% ( p  < 0.001). Improvements in anthropometric measures and functional mobility did not differ between those presenting with or without CMP at baseline. Improvements in pain were not related to the magnitude of weight loss., Conclusion: Weight loss was effective in reducing pain prevalence and improving functional mobility, emphasizing the importance of considering weight-loss as a key component of pain management., Clinical Trial Registration: identifier, ACTRN12618001861246., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ward, Coates, Carter, Baldock, Berryman, Stanton, Yandell, Buckley, Tan, Rogers and Hill.)

Background: Studies evaluating the dietary intake of Australian Football League Women's (AFLW) athletes are few and limited to the preseason. This prospective observational study aims to evaluate seasonal changes in dietary intake and health parameters of professional AFLW athletes., Methodology: Dietary intake (3-day weighed food records), body composition (bioelectrical impedance analysis, skinfolds), physical performance (global positioning system, GPS), and iron status (fasted blood sample) were assessed in 19 athletes (24 ± 5 years, 170 ± 6 cm, 22.8 ± 2.1 kg/m 2 ) at three timepoints: start of preseason, end of preseason, and end of competition season. Sociodemographic information, sports nutrition knowledge (SNK), and risk of low energy availability (LEA) questionnaires were completed at the start of preseason., Results: Mean daily energy and carbohydrate (CHO) intakes were lower than recommendations across all seasons ( p  < 0.05). Mean daily CHO intake was highest at start of preseason (3.6 g/kg/day), decreased during preseason (3.1 g/day) and remained low during competition (3.2 g/day); >80% of players did not meet minimum recommendations at each timepoint (all, p  < 0.05). The sum of seven skinfolds and fat mass (%) decreased during preseason (both, p  < 0.05). Serum iron fell within recommended ranges for 95% of athletes at all timepoints. The total distance (m) and number of Very High Intensity (>21 km/h) efforts significantly increased across preseason and decreased during competition (all, p  < 0.05). Nutrition knowledge was 'poor', and 42% of athletes were at risk of LEA., Conclusions: AFLW athletes do not meet energy and carbohydrate requirements across the preseason and competition seasons, which may impact health and performance if deficits are sustained.

Objectives: The risk of falls increases with age and often requires an emergency medical service (EMS) response. We compared the characteristics of patients attended by EMS in response to repeat falls within 30 days and 12 months of their first EMS-attended fall; and explored the number of days between the index fall and the subsequent fall(s)., Methods: This retrospective cohort study included all adults (> =18 years of age) who experienced their first EMS-attended fall between 1 January 2016 and 31 December 2020, followed up until 31 December 2021. Patients who experienced > =1 subsequent fall, following their first recorded fall, were defined as experiencing repeat falls. Multivariable logistic regression was used to identify the factors associated with repeat falls; and Kaplan-Meier analysis was used to estimate the time (in days) between consecutive EMS-attended falls., Results: A total of 128,588 EMS-attended fall-related incidents occurred involving 77,087 individual patients. Most patients, 54,554 (71%) were attended only once for a fall-related incident (30,280 females; median age 73 years, inter-quartile range (IQR): 55-84). A total of 22,533 (29%) patients experienced repeat EMS-attended falls (13,248 females; median age 83 years, IQR: 74-89, at first call). These 22,533 patients accounted for 58% (74,034 attendances) of all EMS-attendances to fall-related incidents. Time between EMS-attended falls decreased significantly the more falls a patient sustained. Among the 22,533 patients who experienced repeat falls, 13,363 (59%) of repeat falls occurred within 12 months: 3,103 (14%) of patients sustained their second fall within 30 days of their index fall, and 10,260 (46%) between 31 days to 12 months. Patients who were transported to the hospital, via any urgency, at their first EMS-attended fall, had a reduced odds of sustaining a second EMS-attended fall within both 30 days and 31 days to 12 months, compared to non-transported patients., Conclusion: Nearly 30% of all patients attended by EMS for a fall, sustained repeat falls, which collectively accounted for nearly 60% of all EMS-attendances to fall-related incidents. Further exploration of the role EMS clinicians play in identifying and referring patients who sustain repeat falls into alternative pathways is needed.

There is limited evidence about how physical activity (PA) programs should be provided for older Aboriginal and Torres Strait Islander peoples. Recently two groups of Aboriginal Elders on Noongar Boodja (Country) in Western Australia participated in the Ironbark PA program., Issue Addressed: The objective of this study was to explore the views of key stakeholders about the barriers and enablers to delivering a successful PA program and provide feedback for future program delivery., Methods: The research took a 'Nih (listening), Waangkiny (learning), Kaadatjiny (knowing)' approach. The lead researcher, a Noongar Wadjuk woman, conducted semi-structured interviews (n = 17) with key stakeholders: Aboriginal and non-Aboriginal workers who assisted to deliver the program, and family and local members of the communities. Data were also collected through weekly program notes and researcher diary entries. Data were analysed thematically., Results: The overarching theme highlighted that stakeholders felt a sense of building a PA program that was culturally appropriate. They reflected that the program attracted older Aboriginal people because it was designed to make them feel welcomed with a sense of belonging. Five major themes were identified: Relationships, Belonging, Program structure, Benefits of the program and Future planning. Positive changes observed in Elders' health and well-being were a source of inspiration for team workers., Conclusions: Key enablers to delivering a PA program for older Aboriginal people are building a culturally strong program that creates a sense of belonging for the participants. SO WHAT?: Practitioners who are planning PA programs for older Aboriginal people should prioritise the development of cultural safety and security., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Background and Setting: Patients hospitalised with community-acquired pneumonia (CAP) are frequently admitted to an intensive care unit (ICU) for invasive mechanical ventilation and receive treatment by physiotherapists. However, clinical physiotherapy practice is variable for this ICU cohort., Objectives: To develop a clinical practice guideline for physiotherapy management of adults invasively ventilated with CAP using the best available evidence., Methods: Guideline development using evidence synthesis according to the GRADE and JBI approaches, incorporating findings from four preceding phases of a mixed-methods research program: systematic review and meta-analysis, national survey of Australian ICU physiotherapy practice, e-Delphi study to determine expert consensus, and multidisciplinary peer-review of the expert consensus statements by senior ICU clinicians to determine validity and applicability of the statements for translation into practice., Results: The guideline comprises 26 recommendations, encompassing physiotherapy assessment, patient selection and prioritisation, and treatment. Physiotherapy treatment covers domains of humidification, patient positioning, hyperinflation techniques, manual chest wall techniques, normal saline instillation, active treatment, and mobilisation. Recommendations are rated as strong or conditional based on JBI criteria, and certainty of evidence according to GRADE. Considerations for practice are provided within the guideline to enhance clarity and practicality, particularly for conditional recommendations where evidence is limited or conflicting., Conclusion: This guideline, based on the best available evidence for clinical physiotherapy practice for adults invasively ventilated with CAP, is intended to support clinicians with clinical decision making. Further research is required to evaluate guideline implementation into clinical practice, and incorporate the values and preferences of ICU patients and their families. CONTRIBUTION OF PAPER., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Improvisational (improv) theatre skill development holds promise for improving the dementia capability of care partners. In this report, we present analysis of data from an ongoing study on meaningful engagement and quality of life among assisted living (AL) residents with dementia. Using ethnographic methods, we collected data from persons with dementia ( n = 59) and their care partners ( n = 165) in six diverse AL communities each studied for one year. Building cumulatively on past work and existing literature, we demonstrate the potential benefits of training care partners to use improv skills. We discuss implications, including the need for intervention research., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Energy-restricted (ER) diets promote weight loss and improve body composition and glycaemic control. Nut consumption also improves these parameters. However, less is known about the combined benefit of these two strategies. This scoping review implemented a systematic search of Medline, Embase and Scopus to identify randomised controlled trials evaluating the effect of ER diets with or without nuts on body mass, body composition and glycaemic control in adults. After reviewing titles and abstracts, twenty-nine full-text articles were screened, resulting in seven studies reported in eight papers that met the inclusion criteria. Energy restriction was achieved by prescribing a set energy target or reducing intake by 1000-4200 kJ from daily energy requirements. Interventions ranged from 4 to 52 weeks in duration and contained 42-84 g/d of almonds, peanuts, pistachios or walnuts. While all studies reported that energy restriction resulted in significant weight loss, the addition of nuts to ER diets demonstrated significantly greater weight loss in only approximately half of the included studies (4/7 studies). There was limited evidence to support additional benefits from nuts for body composition measures or glycaemic control. Although improvements in weight loss and glycaemia were not consistent when nuts were included in ER diets, no study revealed an adverse effect of nut consumption on health outcomes. Future studies could explore the effect of consuming different types and amounts of nuts, combined with various levels of energy restriction on weight, body composition and glycaemic control.

Introduction Existing randomised controlled trials assessing the safety and efficacy of left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) were of relatively small sample size, or included patients who could receive oral anticoagulant treatment after device implantation. We compared the outcomes of patients with newly diagnosed AF who received percutaneous LAAO or direct oral anticoagulants (DOAC) treatment, in a large population from a global federated health network (TriNetX). Methods Patients with AF treated with percutaneous LAAO were matched with those treated with DOAC between 1st December 2010 and 1st October 2018. Outcomes were all-cause mortality, ischaemic stroke and intracranial haemorrhage (ICH) at 5 years. Results We included 200 patients with AF, who received either LAAO or DOAC. The risk of all-cause mortality, ischaemic stroke and ICH at 5 years was not significantly different between the two groups (Risk Ratio [RR] for all-cause mortality: 1.52, 95% confidence interval (CI): 0.97- 2.38, RR for ischaemic stroke: 1.09, 95% CI: 0.51- 2.36, and RR for ICH: 1.0, 95% CI: 0.44- 2.30). Conclusion Patients newly diagnosed with AF, eligible for DOAC, showed similar 5-year risk of death, ischemic stroke, and ICH when comparing those who underwent percutaneous LAAO to those receiving DOAC. Future randomised controlled trials are needed to confirm the findings and advise changes in guidelines., (S. Karger AG, Basel.)

To synthesise the best available evidence for the effectiveness of interventions delivered in community-based rehabilitation (CBR) centers on physical fitness, for community-dwelling older adults living in Asian countries. This study is a systematic review and meta-analysis. Seven English and two Chinese electronic databases were searched for randomised controlled trials (RCTs) and quasi-experimental studies that were conducted by centers providing CBR. Independent reviewers screened, quality-appraised and extracted data. The primary outcome was physical fitness measured by validated assessment tools, including the Timed Up and Go Test (TUG), gait speed, hand grip strength, Functional Reach Test (FRT), and one-leg standing test. Assessments of activity of daily living and quality of life using tools including the Barthel Index, Short Form (SF)-12, and SF-36 were secondary outcomes. After screening 5,272 studies, 29 studies were included (16 RCTs, 13 quasi-experimental studies) from four countries. Meta-analyses found that CBR programs significantly decreased TUG time (mean difference [MD], -1.89 seconds; 95% confidence interval [95% CI], -2.84 to -0.94; I2=0%; Z=3.90, p<0.0001), improved gait speed (MD, 0.10 m/s; 95% CI, 0.01-0.18; I2=0%; Z=2.26, p=0.02), and increased one-leg standing time (MD, 2.81 seconds; 95% CI, 0.41-5.22; I2=0%; Z=2.29, p=0.02). Handgrip strength and FRT showed no statistically significant improvement in the meta-analyses. CBR may improve aspects of physical fitness for older adults in Asian countries. However, variability in intervention components and measurement tools reduced the ability to pool individual studies. Further trials are required with robust designs including standardised measures of physical fitness.

Introduction: Previous research has associated high dietary cholesterol intake with raised low-density lipoprotein cholesterol (LDL-C) and thus increased risk for cardiovascular disease (CVD). Emerging research suggests that it is saturated fat, not dietary cholesterol, associated with increased CVD risk. Despite being high in cholesterol, eggs, low in saturated fat, are not adversely associated with blood lipids or CVD risk. This paper describes a randomised controlled counter-balanced, cross-over trial assessing the effects of a high-cholesterol/low-saturated fat (egg) diet and a low-cholesterol/high-saturated fat diet (egg free) on blood lipids and lipoproteins, while accounting for physical activity levels which can also influence these parameters. The primary aim is to demonstrate that high cholesterol intake (from eggs) within a healthy, low-saturated fat diet does not adversely affect blood lipid levels and lipoprotein profiles. Instead, we propose that adverse effects on these parameters are mediated by saturated fat intake. The secondary aim is to explore relationships between changes in blood lutein and zeaxanthin concentrations and alterations in physical activity, examining whether changes in physical activity mediate effects on blood lipids and lipoproteins., Methods and Analysis: Fifty-two adults aged 18-60 years with LDL-C less than 3.5 mmol/L will be randomly allocated to three isocaloric diets for 5 weeks each: a high-cholesterol (600 mg)/low-saturated fat (6%) (egg) diet, a low-cholesterol (300 mg)/high-saturated fat (12%) (egg free) diet and a control diet that is high in both cholesterol (600 mg) and saturated fat (12%). Lipid and lipoprotein levels, lipoprotein size and concentrations, blood pressure, blood glucose, physical activity levels, and plasma lutein and zeaxanthin concentrations will be measured. Treatment effects will be analysed using linear mixed effects models., Ethics and Dissemination: Ethics approval was obtained from the University of South Australia Human Research Ethics Committee no. 204 327. Results will be disseminated through peer-reviewed journals and national and international presentations., Trial Registration Number: NCT05267522., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Nutrition-related factors linked to pain chronicity and disability include weight status and dietary behaviours. Dietary patterns associated with concurrent pain episodes, however, remain poorly characterised. This paper outlines the protocol for a feasibility study that aims to characterise pain-related dietary and lifestyle behaviours in people experiencing chronic musculoskeletal pain., Methods: The study will recruit participants who experience musculoskeletal pain on 5 or more days of the week for at least 3 months. Participants will attend two in-person clinic visits where physical measurements and a series of pain and lifestyle questionnaires will be completed. Visits will be conducted pre and post a 2-week self-monitoring period where participants will self-report concurrent diet, sleep, mood, and pain on four days and will wear a wrist-worn activity monitor (GENEActiv). Key feasibility metrics will evaluate participant recruitment, enrolment and retention rates, and compliance with the study data collection protocol., Discussion: There remains a lack of evidence behind dietary advice as an adjunct pain management tool. Upon completion of the protocol, feasibility outcomes will identify challenges to guide the design and delivery of a dietary intervention for chronic musculoskeletal pain., (© 2024. The Author(s).)

Objective: To examine the feasibility of using allied health assistants to deliver patient falls prevention education within 48 h after hospital admission., Design and Setting: Feasibility study with hospital patients randomly allocated to usual care or usual care plus additional patient falls prevention education delivered by supervised allied health assistants using an evidence-based scripted conversation and educational pamphlet., Participants: (i) allied health assistants and (ii) patients admitted to participating hospital wards over a 20-week period., Outcomes: (i) feasibility of allied health assistant delivery of patient education; (ii) hospital falls per 1,000 bed days; (iii) injurious falls; (iv) number of falls requiring transfer to an acute medical facility., Results: 541 patients participated (median age 81 years); 270 control group and 271 experimental group. Allied health assistants (n = 12) delivered scripted education sessions to 254 patients in the experimental group, 97% within 24 h after admission. There were 32 falls in the control group and 22 in the experimental group. The falls rate was 8.07 falls per 1,000 bed days in the control group and 5.69 falls per 1,000 bed days for the experimental group (incidence rate ratio = 0.66 (95% CI 0.32, 1.36; P = 0.26)). There were 2.02 injurious falls per 1,000 bed days for the control group and 1.03 for the experimental group. Nine falls (7 control, 2 experimental) required transfer to an acute facility. No adverse events were attributable to the experimental group intervention., Conclusions: It is feasible and of benefit to supplement usual care with patient education delivered by allied health assistants., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

This pilot study aimed to examine EVOLVE UK extra care housing tool in an Australian residential aged care minor refurbishment context. The tool's content validity was established with 34 subcategories (I-CVI ≥0.75) and 612 statements (n = 509 I-CVI ≥0.75) relevant. A subsequent audit indicated high concordance (Rho-C = 0.750 to 0.997) within four experts' ratings of the care facility and correlation (Kendall's τ-statistic) between raters ranged from strong (0.5 to 0.9) to very strong (0.9 to 1.0). Lighting was the highest refurbishment element represented (50.54%). Assessment can inform funding, demonstrate standards compliance, and the components of physical environment refurbishments which support resident function.

Purpose of Review: Dietary patterns that include polyphenols may help manage cardiometabolic risk factors. Pigmented rice contains phenolic acids and flavonoids that contribute to its antioxidant properties. This review examined the effect of polyphenol-containing pigmented rice on antioxidant status, lipid profile, glucose/insulin, blood pressure, and weight among adults. Four electronic databases including PubMed, ProQuest, EBSCOhost, and Google Scholar were systematically searched for relevant articles published in English since 2000, using PRISMA guidelines (PROSPERO registration: CRD42022358132). Two-staged screening resulted in the inclusion of seventeen (seven acute, ten chronic) randomized controlled trials. A random effects model was conducted on cardiometabolic outcomes reported in at least three studies., Recent Findings: Acute intake increased plasma antioxidant activity and lowered postprandial glucose and insulin levels. Chronic consumption was associated with reductions in fasting glucose (WMD: -1.60 mg/dL; 95% CI:-3.05,-0.14, p = 0.03, k = 5, n = 349), weight (WMD: -0.23 kg, 95% CI: -0.44, -0.02, p = 0.03, k = 3, n = 182), and diastolic blood pressure (WMD: -1.39 mmHg, 95% CI: -2.21, -0.56, p = 0.001, k = 3, n = 185). No effect on total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, body mass index, and systolic blood pressure was found. The consumption of pigmented rice may improve cardiometabolic risk factors. However, the small number of studies and differences in study design, including participants' health status, form of rice utilized, and duration of intervention, support the need for more high-quality trials to further investigate these findings., (© 2023. The Author(s).)

Background: Emergency Medical Services (EMS) are attending an increasing number of adults who fall. This study aimed to describe the incidence, patient characteristics, treatments and disposition of ambulance attended patients who fell in Western Australia (WA)., Methods: An ordinal logistic regression (using STATA) was conducted in this retrospective cohort study, analysing predictors of lower compared to higher transport urgency levels. Participants were adults ( ≥ 18 years) who fell and required ambulance attendance in WA between 1st January 2015 - 31st December 2021., Results: A total of 188,720 patients (female = 107,811, 57 %) were attended by ambulances after falls, (median age = 80 years [IQR 67-87]). The age-standardized incidence rate of ambulance attended falls increased from 115 cases/100,000 person-years to 161 cases/100,000 person-years between 2015 and 2021. A total of 89,140 (47 %) patients had an injury recorded by paramedics, most often lacerations or suspected fractures. The electronic patient care record showed, 50,044 (26.5 %) patients received medication and 30,954 (16.4 %) patients received other intervention, e.g., ECG. A total of 148,050 (78 %) patients were transported to hospital with the following urgency levels: 2,371 (2 %) via urgency one; 27,882 (19 %) via urgency two, 93,447 (63 %) via urgency three and 22,584 (15 %) via urgency four and five ( < 1 % unknown urgency). Positive predictors of lower level transport urgency to hospital included being female and older than 65 years of age., Conclusion: Older, female patients had higher odds of being transported via a lower urgency, with 50 % of this cohort transported via urgency three. While 19 % of patients were attended via a Priority one, only 1 % were transported to hospital via urgency one. The incidence rate of falls requiring ambulance attendance has increased over time, increasing the demand placed on EMS annually., Competing Interests: Declaration of Competing Interest The author declares no conflict of interest., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Complex challenges face clinicians managing critically ill patients with burns, particularly in the context of enhancing outcomes after a stay in ICU. Compounding this, a dearth of research explores the specific and modifiable factors that impact early mobilization in the ICU environment., Aim: To explore the barriers and enablers of early functional mobilization for patients with burns in the ICU from a multidisciplinary perspective., Design: A qualitative phenomenological study., Methods: Semi-structured interviews supplemented by online questionnaires conducted with 12 multidisciplinary clinicians (four doctors, three nurses and five physical therapists) who previously managed burn patients at a quaternary level ICU. Data were thematically analysed., Results: Four main themes: patient, ICU clinicians, the workplace and the physical therapist were identified as impacting on early mobilization. Subthemes identified barriers or enablers to mobilization but all were strongly influenced by overarching theme of the clinician's "emotional filter." Barriers included high levels of pain, heavy sedation and low levels of clinician exposure to treating patients with burns. Enablers included higher levels of clinician's experience and knowledge about burn management and benefits of early mobilization; increased coordinated staff resources when undertaking mobilization; and, open communication and positive culture towards early mobilization across the multidisciplinary team., Conclusion: Patient, clinician and workplace barriers and enablers were identified to influencing the likelihood of achieving early mobilization of patients with burns in the ICU. Emotional support for staff through multidisciplinary collaboration and development of structured burns training program were key recommendations to address barriers and strengthen enablers to early mobilization of patients with burns in the ICU., Competing Interests: Competing interests Not applicable., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Objective: This study evaluated weight and cardiometabolic outcomes after a 3-month energy-restricted diet (-30%) containing almonds (almond-enriched diet [AED]) or containing carbohydrate-rich snacks (nut-free control diet [NFD]) (Phase 1), followed by 6 months of weight maintenance (Phase 2)., Methods: Participants (25-65 years old) with overweight or obesity (BMI 27.5-34.9 kg/m 2 ) were randomly allocated to AED (n = 68) or NFD (n = 72)., Results: Both groups lost weight during Phase 1 (p < 0.001) (mean [SE], -7.0 [0.5] kg AED vs. -7.0 [0.5] kg NFD, p = 0.858) and Phase 2 (p = 0.009) (-1.1 [0.5] kg AED vs. -1.3 [0.6] NFD, p = 0.756), with improvements in percentage lean mass after Phase 2 (4.8% [0.3%], p < 0.001). Reductions occurred in fasting glucose (-0.2 [0.07] mmol/L, p = 0.003), insulin (-8.1 [4.0] pmol/L, p = 0.036), blood pressure (-4.9 [0.8] mm Hg systolic, -5.0 [0.5] mm Hg diastolic, p < 0.001), total cholesterol (-0.3 [0.1] mmol/L), low-density lipoprotein (LDL) (-0.2 [0.1] mmol/L), very low-density lipoprotein (-0.1 [0.03] mmol/L), and triglycerides (-0.3 [0.06] mmol/L) (all p < 0.001), and high-density lipoprotein increased (0.1 [0.02] mmol/L, p = 0.011) by the end of Phase 2 in both groups. There were group by time interactions for lipoprotein particle concentrations: very small triglyceride-rich (-31.0 [7.7] nmol/L AED vs. -4.8 [7.9] nmol/L NFD, p = 0.007), small LDL (-109.3 [40.5] nmol/L AED vs. -20.7 [41.6] nmol/L NFD, p = 0.017), and medium LDL (-24.4 [43.4] nmol/L AED vs. -130.5 [44.4] nmol/L NFD, p = 0.045)., Conclusions: An energy-restricted AED resulted in weight loss and weight loss maintenance comparable to an energy-restricted NFD, and both diets supported cardiometabolic health. The AED resulted in greater improvements in some lipoprotein subfractions, which may enhance reductions in cardiovascular risk., (© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Purpose of Review: This review summarizes recent evidence published since a previous review in 2018 on the association between egg consumption and risk of cardiovascular disease (CVD) mortality, CVD incidence, and CVD risk factors., Recent Findings: No recent randomized controlled trials were identified. Evidence from observational studies is mixed, with studies reporting either an increased risk or no association of highest egg consumption with CVD mortality, and a similar spread of increased risk, decreased risk, or no association between egg intake and total CVD incidence. Most studies reported a reduced risk or no association between egg consumption and CVD risk factors. Included studies reported low and high egg intake as between 0 and 1.9 eggs/week and 2 and ≥14 eggs/week, respectively. Ethnicity may influence the risk of CVD with egg consumption, likely due to differences in how eggs are consumed in the diet rather than eggs themselves. Recent findings are inconsistent regarding the possible relationship between egg consumption and CVD mortality and morbidity. Dietary guidance should focus on improving the overall quality of the diet to promote cardiovascular health., (© 2023. The Author(s).)

Background: The drug-drug interaction between rifampicin and dolutegravir can be overcome by supplemental dolutegravir dosing, which is difficult to implement in high-burden settings. We aimed to test whether virological outcomes with standard-dose dolutegravir-based antiretroviral therapy (ART) are acceptable in people with HIV on rifampicin-based antituberculosis therapy., Methods: RADIANT-TB was a phase 2b, randomised, double-blind, non-comparative, placebo-controlled trial at a single site in Khayelitsha, Cape Town, South Africa. Participants were older than 18 years of age, with plasma HIV-1 RNA greater than 1000 copies per mL, CD4 count greater than 100 cells per μL, ART-naive or first-line ART interrupted, and on rifampicin-based antituberculosis therapy for less than 3 months. By use of permuted block (block size of 6) randomisation, participants were assigned (1:1) to receive either tenofovir disoproxil fumarate, lamivudine, and dolutegravir plus supplemental 50 mg dolutegravir 12 h later or tenofovir disoproxil fumarate, lamivudine, and dolutegravir plus matched placebo 12 h later. Participants received standard antituberculosis therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol for the first 2 months followed by isoniazid and rifampicin for 4 months). The primary outcome was the proportion of participants with virological suppression (HIV-1 RNA <50 copies per mL) at week 24 analysed in the modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03851588., Findings: Between Nov 28, 2019, and July 23, 2021, 108 participants (38 female, median age 35 years [IQR 31-40]) were randomly assigned to supplemental dolutegravir (n=53) or placebo (n=55). Median baseline CD4 count was 188 cells per μL (IQR 145-316) and median HIV-1 RNA was 5·2 log 10 copies per mL (4·6-5·7). At week 24, 43 (83%, 95% CI 70-92) of 52 participants in the supplemental dolutegravir arm and 44 (83%, 95% CI 70-92) of 53 participants in the placebo arm had virological suppression. No treatment-emergent dolutegravir resistance mutations were detected up to week 48 in the 19 participants with study-defined virological failure. Grade 3 and 4 adverse events were similarly distributed between the study arms. The most frequent grade 3 and 4 adverse events were weight loss (4/108 [4%]), insomnia (3/108 [3%]), and pneumonia (3/108 [3%])., Interpretation: Our findings suggest that twice-daily dolutegravir might be unnecessary in people with HIV-associated tuberculosis., Funding: Wellcome Trust., Competing Interests: Declaration of interests BS did statistical analysis for HIV-related and tuberculosis-related clinical trials for MetaVirology. GMe lectured for Gilead Sciences and participated in a data safety monitoring board or advisory board for Otsuka. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives There is limited evidence regarding the effectiveness of transition care programs (TCP) in improving health-related outcomes and discharge destination for older adults. This study aimed to (i) identify changes in health-related outcomes in older adults undergoing a facility-based TCP between admission and discharge; and (ii) compare health-related outcomes between participants discharged home and those discharged to permanent residential care. Method A prospective, observational study was conducted with older adults aged ≥60 years who participated in a facility-based TCP that provided short-term rehabilitation including mobility training, group exercise and cognitive activities. Physical, cognitive and social outcomes were measured at admission and discharge. Data were analysed using linear mixed modelling. Results Of the 41 participants (mean age 80.1 (±8.9) years), 26 (63.4%) were discharged home compared with 14 (34.2%) to residential care. Participants showed statistically significantly improvement in performance of activities of daily living (ADL), mobility and health-related quality of life, with a statistically and clinically significant decline in performance of instrumental ADL. Participants discharged home had statistically and clinically significant greater improvement in mobility compared with those discharged to residential care (de Morton mobility index: home, 13.6 (95% CI: 9.8, 17.4) vs residential, 6.9 (95% CI: 1.7, 12.0), P interaction  = 0.04) and statistically and clinically significant less decline in instrumental ADL (Lawton's scale: home, -0.8 (95% CI: -1.3, -0.2) vs residential, -2.1 (95% CI: -2.9, -1.4), P interaction  = 0.002). Conclusion Older adults participating in a facility-based TCP had improvements in physical, cognitive and social functional abilities. However, those who returned home still had residual mobility deficits and decreased performance of instrumental ADL when compared with normative community level recommendations, which could impact on longer term community living. Further research investigating which program service components could be modified to further improve rehabilitation outcomes could benefit older adults in returning and remaining at home.

Abstract: The fear of being devalued or discriminated against is a salient deterrent to seeking mental health care, especially in communities of color where racial stigma also impacts mental health and perceptions of service utilization. To address this issue, our research team partnered with This Is My Brave Inc to develop and evaluate a virtual storytelling intervention to highlight and amplify the voices of Black and Brown Americans living with mental illness and/or addiction. We utilized a pretest-posttest survey design administered electronically to viewers of the series ( n = 100 Black, indigenous, people of color and n = 144 non-Hispanic White). Results indicated that postintervention, scores on public stigma and perceived discrimination measures were significantly reduced. We identified significant interaction effects, such that Black, indigenous, people of color viewers showed a greater rate of improvement on outcomes. This study provides strong preliminary evidence of the impact of a culturally meaningful virtual approach to addressing stigma and improving attitudes about mental health treatment., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Meaningful engagement is a key dimension of quality of life among persons living with dementia, yet little is known about how to best to promote it. Guided by grounded theory methods, we present analysis of data collected over a 1-year period in four diverse assisted living (AL) communities as part of the study, "Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia." Our aims are to: (a) learn how meaningful engagement is negotiated among AL residents with dementia and their care partners; and (b) identify how to create these positive encounters. Researchers followed 33 residents and 100 care partners (formal and informal) and used participant observation, resident record review, and semi-structured interviews. Data analysis identified "engagement capacity" as central to the negotiation of meaningful engagement. We conclude that understanding and optimizing the engagement capacities of residents, care partners, care convoys, and settings, are essential to creating and enhancing meaningful engagement among persons living with dementia.

Purpose: Early satiety has been identified as one of the mechanisms that may explain the beneficial effects of nuts for reducing obesity. This study compared postprandial changes in appetite-regulating hormones and self-reported appetite ratings after consuming almonds (AL, 15% of energy requirement) or an isocaloric carbohydrate-rich snack bar (SB)., Methods: This is a sub-analysis of baseline assessments of a larger parallel-arm randomised controlled trial in overweight and obese (Body Mass Index 27.5-34.9 kg/m 2 ) adults (25-65 years). After an overnight fast, 140 participants consumed a randomly allocated snack (AL [n = 68] or SB [n = 72]). Appetite-regulating hormones and self-reported appetite sensations, measured using visual analogue scales, were assessed immediately before snack food consumption, and at 30, 60, 90 and 120 min following snack consumption. A sub-set of participants (AL, n = 49; SB, n = 48) then consumed a meal challenge buffet ad libitum to assess subsequent energy intake. An additional appetite rating assessment was administered post buffet at 150 min., Results: Postprandial C-peptide area under the curve (AUC) response was 47% smaller with AL compared to SB (p < 0.001). Glucose-dependent insulinotropic polypeptide, glucagon and pancreatic polypeptide AUC responses were larger with AL compared to SB (18%, p = 0.005; 39% p < 0.001; 45% p < 0.001 respectively). Cholecystokinin, ghrelin, glucagon-like peptide-1, leptin and polypeptide YY AUCs were not different between groups. Self-reported appetite ratings and energy intake following the buffet did not differ between groups., Conclusion: More favourable appetite-regulating hormone responses to AL did not translate into better self-reported appetite or reduced short-term energy consumption. Future studies should investigate implications for longer term appetite regulation., Anzctr Reference Number: ACTRN12618001861246 2018., (© 2022. The Author(s).)

Background: The ageing population is requiring more ambulance attendances for falls. This scoping review aimed to map and synthesise the evidence for the prehospital management of Emergency Medical Services (EMS) attended adult patients who fall., Methods: The Joanna Briggs Institute methods for scoping reviews were used. Six databases were searched (Medline, Scopus, CINAHL, Cochrane, EMBASE, ProQuest), 1st August 2021. Included sources reported: ambulance attended (context), adults who fell (population), injuries, interventions or disposition data (concept). Data were narratively synthesised., Results: One-hundred and fifteen research sources met the inclusion criteria. Detailed information describing prehospital delivered EMS interventions, transport decisions and alternative care pathways was limited. Overall, adults< 65 years were less likely than older adults to be attended repeatedly and/or not transported. Being male, falling from height and sustaining severe injuries were associated with transport to major trauma centres. Older females, falling from standing/low height with minor injuries were less likely to be transported to major trauma centres., Conclusion: The relationship between patient characteristics, falls and resulting injuries were well described in the literature. Other evidence about EMS management in prehospital settings was limited. Further research regarding prehospital interventions, transport decisions and alternative care pathways in the prehospital setting is recommended., (Copyright © 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Resistance training (RT) is beneficial for older adults, particularly to support living independently in their home. However, fewer than 25% of older adults in Australia participate in the recommended, twice-weekly sessions. Reasons older adults do not participate in RT include not having anyone to go with or not knowing what to do. Our study linked older adults with a peer (i.e., older person already participating in RT) to help them overcome these barriers. The aim of our study was to determine whether peer support was suitable for older adults participating in RT for the first time in the home or gymnasium setting. Each group (home vs. gymnasium) received a 6 week, twice-weekly program. Twenty-one participants completed the 6 week intervention: 14 in the home group and seven in the gymnasium group. The home group completed significantly more sessions per week (2.7 vs. 1.8) than the gymnasium group. Although both groups significantly improved on many physical assessments, no between-group differences were found. However, it is suitable to link a peer for support with novice older people participating in a RT program for the first time in the home or gymnasium. It is recommended that future studies explore whether peer support improves sustainability.

Background: Being physically active and socially connected is positively associated with healthy aging. Older adults living in the community may be at risk of social isolation and reduced physical activity, especially in recent times due to COVID-19. There are many programs that offer opportunities for evidence-based physical activity or social connection; however, there is a lack of programs that include both. The objective of this study was to explore the lived experience of older adults who participated in Connect 60+ - a program that promoted exercise and social activities - delivered from a community hub that could be attended either in person or online., Methods: A qualitative study that used descriptive phenomenology was conducted. A purposive sample of 13 older adults (age ≥65years) was recruited to take part in semistructured telephone interviews to discuss barriers and enablers to program engagement. Data were analysed using thematic analysis., Results: The overarching theme was that participating in Connect 60+ was an enjoyable and encouraging experience for participants. The program enabled them to increase their physical activity and build social connections within their community. The main themes that enabled engagement were: (1) an enabling program design, (2) developing new connections in the community, and (3) experiencing motivation to engage. A few barriers were identified, including difficulties connecting online and lack of male attendance., Conclusions: Wellness programs delivered in community hubs may facilitate older adults to increase their engagement in both physical and social activity. The program appeared to impact positively on participants' motivation, with some participants reporting that they had sustained their behaviour changes since program completion. To address identified barriers, easy to use online technology is recommended, and strategies to promote male attendance.

Background: Community hubs offer a pragmatic approach to address the wellness needs for older adults at risk of social isolation and declining physical activity., Objective: The current study evaluated the effectiveness of a wellness program delivered from a community hub (either in person or online) on exercise and social connections of community-dwelling older adults living in Australia during a time of social isolation imposed by COVID-19., Methods: A single group pre-post quasi-experimental study was conducted online and in person from a community hub. The 9-week program (CONNECT60+) was designed using a community-based participatory approach. It consisted of weekly group exercises led by a health professional and a wellness activity that aligned with active ageing guidelines, such as education, book club, and nature walks. Participants were encouraged to complete daily wellness activities and record these in a workbook. Data were gathered at pretest and 10-week post-test using questionnaires., Results: A total of 47 participants completed the program. Most participants were aged between 64 and 74 years (61.7%), and 82.9% were female. Thirty-five participants (74.5%) attended the program in person, and 12 (25.5%) attended online from home. Preliminary findings showed participants prioritized social connections during the week and increased the duration (median [interquartile range] minutes) of exercise completed per week (pretest: 285 minutes (inter-quartile range, 246-567 minutes); post-test: 346 minutes (interquartile range, 150-415 minutes); P &lt; .01)., Conclusions: The study endorsed the wellness program delivered in person and online from a community hub to enable older adults to complete wellness activities, including exercise and socially connecting during a time of self-isolation due to the COVID-19 pandemic.

The expression of a mutant Lamin A, progerin, in Hutchinson-Gilford Progeria Syndrome leads to alterations in genome architecture, nuclear morphology, epigenetic states, and altered phenotypes in all cells of the mesenchymal lineage. Here, we report a comprehensive analysis of the transcriptional status of patient derived HGPS fibroblasts, including nine cell lines not previously reported, in comparison with age-matched controls, adults, and old adults. We find that Progeria fibroblasts carry abnormal transcriptional signatures, centering around several functional hubs: DNA maintenance and epigenetics, bone development and homeostasis, blood vessel maturation and development, fat deposition and lipid management, and processes related to muscle growth. Stratification of patients by age revealed misregulated expression of genes related to endochondral ossification and chondrogenic commitment in children aged 4-7 years old, where this differentiation program starts in earnest. Hi-C measurements on patient fibroblasts show weakening of genome compartmentalization strength but increases in TAD strength. While the majority of gene misregulation occurs in regions which do not change spatial chromosome organization, some expression changes in key mesenchymal lineage genes coincide with lamin associated domain misregulation and shifts in genome compartmentalization., Competing Interests: RS, PD, JS, AH, RM No competing interests declared, (© 2022, San Martin et al.)

Background: Community rehabilitation for older people after hospital discharge is necessary to regain functional ability and independence. However, poor adherence to exercise programs continues to hinder achieving positive health outcomes in older people. This study aimed to evaluate the effectiveness of prescribing a tailored video self-modeled DVD-HEP for 6 weeks, on functional mobility, physical activity, exercise self-efficacy, and health-related quality of life, in a sample of frail older adults., Materials and Methods: A pre- and post-test intervention study design was conducted, with each participant acting as their own control. A convergent, parallel, mixed-methods approach involving quantitative, and qualitative data collection was used. Participants received an individualized assessment at baseline and subsequently were provided with a 30-min tailored 6-week self-modeled DVD-HEP that showed the physiotherapist instructing the participant. The physiotherapist phoned participants fortnightly to encourage engagement in the program and explore responses to it. Outcomes evaluated included functional mobility, balance, gait speed, and exercise self-efficacy., Results: Participants ( n = 15) showed clinically meaningful improvements at follow-up compared to baseline in functional mobility (TUG MCID = 3.4-3.5 s, 3-MWT MCID = 0.1-0.2 m/s) and gait speed (3-MWT MCID = 0.1-0.2 m/s). There were also significant improvements in balance and self-efficacy for exercise and a 2.5- and a 1.3-fold increase in moderate and light physical activity participation at follow-up compared to baseline. The deductive themes were: (i) Enjoyment, self-efficacy, and wellbeing; (ii) Achieving life goals; (iii) Background music as a motivator to adherence; and (iv) Enhanced motor performance and learning: Task goal mastery, multimodal feedback, autonomy to self-regulate learning. The new inductive theme was (v) Preference for in-person support for exercise., Conclusion: Future studies are warranted to compare a tailored self-modeled video HEP to face-to-face programs and other digital health modalities to evaluate older adults' adherence levels and functional improvement., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Vaz, Hang, Codde, Bruce, Spilsbury and Hill.)

A novel pathway for the formation of multiparticle-multihole excited states in rare isotopes is reported from highly energy- and momentum-dissipative inelastic-scattering events measured in reactions of an intermediate-energy beam of ^{38}Ca on a Be target. The negative-parity, complex-structure final states in ^{38}Ca are observed following the in-beam γ-ray spectroscopy of events in the ^{9}Be(^{38}Ca,^{38}Ca+γ)X reaction in which the scattered projectile loses longitudinal momentum of order Δp&#95;{||}=700  MeV/c. The characteristics of the observed final states are discussed and found to be consistent with the formation of excited states involving the rearrangement of multiple nucleons in a single, highly energetic projectile-target collision. Unlike the far-less-dissipative, surface-grazing reactions usually exploited for the in-beam γ-ray spectroscopy of rare isotopes, these more energetic collisions appear to offer a practical pathway to nuclear-structure studies of more complex multiparticle configurations in rare isotopes-final states conventionally thought to be out of reach with high-luminosity fast-beam-induced reactions.

The ice-covered Arctic Ocean constitutes a unique underwater acoustic waveguide; it is a half-channel, upward refracting environment possessing a rough upper boundary consisting of sea ice of varying thickness. The sea ice itself is an acoustic waveguide, capable of supporting the propagation of compressional and shear waves. In particular, the ice supports compressional wave resonances created by impulsive forces on the upper surface of the ice. During ICEX20 and ICEX22, observations were made of compressional wave resonances excited by hammer drops, as well as by near-impulsive signals generated from the compression of dry snow underfoot while walking on the ice. Results demonstrate that ice thickness can be inferred from compressional wave resonances in the sea ice waveguide using signals generated by walking on the snow-covered ice. Inferred ice thickness estimates were consistent with observations made by magnetic induction and physical measurements in holes drilled through the ice. Average first- and multi-year ice thicknesses were inferred to be 1.1-1.3 m and 2.4-2.5 m, respectively.

Background: Recent studies reported that children on mechanical ventilation who were managed with an analgosedation approach and standardized extubation readiness testing experienced better outcomes, including decreased delirium and invasive mechanical ventilation duration., Methods: This was a quality improvement project in a 24-bed pediatric ICU within a single center, including subjects ≤ 18 years old who required invasive mechanical ventilation via an oral or nasal endotracheal tube. The aim was to decrease the invasive mechanical ventilation duration for all the subjects by 25% within 9 months through the development and implementation of bundled benzodiazepine-sparing analgosedation and extubation readiness testing clinical pathways., Results: In the pre-implementation cohort, there were 274 encounters, with 253 (92.3%) that met inclusion for ending in an extubation attempt. In the implementation cohort, there were 367 encounters with 332 (90.5%) that ended in an extubation attempt. The mean invasive mechanical ventilation duration decreased by 23% (Pre 3.95 d vs Post 3.1 d; P = .039) after the implementation without a change in the mean pediatric ICU length of stay (Pre 7.5 d vs Post 6.5 d; P = .42). No difference in unplanned extubation ( P > .99) or extubation failure rates ( P = .67) were demonstrated. Sedation levels as evaluated by the mean State Behavioral Scale were similar (Pre -1.0 vs Post -1.1; P = .09). The median total benzodiazepine dose administered decreased by 75% (Pre 0.4 vs Post 0.1 mg/kg/ventilated day; P < .001). No difference in narcotic withdrawal (Pre 17.8% vs Post 16.4%; P = .65) or with delirium treatment (Pre 5.5% vs Post 8.7%; P = .14) was demonstrated., Conclusions: A multidisciplinary, bundled benzodiazepine-sparing analgosedation and extubation readiness testing approach resulted in a reduction in mechanical ventilation duration and benzodiazepine exposure without impacting key balancing measures. External validity needs to be evaluated in similar centers and consensus on best practices developed., (Copyright © 2022 by Daedalus Enterprises.)

Introduction: The increasing ageing population has become a substantial challenge for both healthcare and social services in many Asian countries. There is a high incidence of chronic diseases and comorbidities in older populations, leading to impairments and functional disability. Functional disability may result in loss of independence, reduced quality of life and increased care needs. Community-based rehabilitation (CBR) provides rehabilitation to improve physical, mental and social outcomes. However, there is limited evidence regarding the effectiveness of CBR for improving older adults' physical fitness. The aim of this systematic review is to synthesise the evidence for the effectiveness of interventions delivered by CBR centres on physical fitness of community-dwelling older adults in Asian countries., Methods and Analysis: A search on four English databases (CINAHL, Medline, Scopus and Proquest) and two Chinese databases (China National Knowledge Internet and Wanfang Database) will be conducted from inception to 15 November 2021. Both English and Chinese publications will be included. Studies conducted in Asian countries using either experimental or quasi-experimental designs, with any type of control group, will be included. The primary outcomes are physical fitness (capacity to perform activities and tasks). Secondary outcomes are performance of activities of daily living and health-related quality of life. The quality of all included studies will be assessed using the Joanna Briggs Institute standardised critical appraisal tools. Two reviewers will independently complete study screening, selection, quality appraisal and data extraction. Quantitative data where possible will be pooled in statistical meta-analysis. All statistical analyses will be performed using Review Manager (Rev Man) V.5.3 software., Ethics and Dissemination: Ethical approval is not required for this review. Findings of the review will be disseminated electronically through a peer-reviewed publication and conference presentations. This review will provide high-quality evidence for CBR in Asian countries with growing ageing populations. Clinical and research recommendations will provide guidance for policy makers and clinical programmes in Asian healthcare systems. Findings will also inform healthcare systems in other countries that use CBR., Prospero Registration Number: CRD42021292088., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Exercise interventions can improve physical recovery and reduce falls in older adults following hospitalization. The aim of the study was to identify factors associated with exercise engagement after hospital discharge., Methods: This study was a secondary analysis of data collected as part of a randomized controlled trial. Participants were 60 years and older, discharged from 3 rehabilitation hospitals in Australia, and followed for 6 months after discharge. The primary outcome was level of engagement in exercise after discharge, measured using setting, type, frequency, and time. A secondary outcome was self-efficacy for exercise at 6-month follow-up. Data were gathered at baseline in hospital and at 6 months after discharge by telephone using structured surveys. Associations between exercise and participant characteristics were evaluated using logistic regression models., Results and Discussion: Participants' (n = 292) mean age was 78 (SD 8) years and 63% were female. There were 146 (50%) who exercised after hospitalization for a median (interquartile range) time of 60 (60-75) minutes per week. Characteristics that were significantly associated with post-discharge engagement in exercise were having higher levels of functional ability at discharge (adjusted odds ratio [AOR] 1.2, 95% CI 1.0, 1.4), living with a partner (AOR 2.9, 95% CI 1.7, 4.9), and engagement in exercise prior to hospital admission (AOR 1.7, 95% CI 1.0, 2.8). The mean self-efficacy for exercise score at 6 months post-discharge was 58.5/90 (SD 24.5). Characteristics that were significantly predictive of a higher mean self-efficacy score at 6 months after hospitalization were having a college or university education (adjusted β-coefficient [Adj β] 11.5, 95% CI 3.8, 19.0), exercise prior to hospital admission (Adj β 12.3, 95% CI 5.1, 19.5), living with a partner at discharge (Adj β 14.5, 95% CI 7.1, 21.9), and higher functional ability at discharge (Adj β 4.0, 95% CI 1.9, 6.1)., Conclusion: Older adults have low levels of engagement in exercise that might impact their recovery after hospitalization. During exercise prescription, clinicians should prioritize older adults who live alone, who have lower functional ability, and no previous habit of exercising., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 APTA Geriatrics, An Academy of the American Physical Therapy Association.)